Safety and palliative efficacy of single-dose 8-Gy reirradiation for painful local failure in patients with stage IV non-small cell lung cancer previously treated with radical chemoradiation therapy.

PURPOSE: To investigate the safety and efficacy of single-dose 8-Gy palliative chest reirradiation (CRI) in metastatic non-small cell lung cancer (M-NSCLC) patients with painful thoracic failures (TF) within the previous radiation portal. PATIENTS AND METHODS: We retrospectively analyzed the clinical data of 78 M-NSCLC patients who received single-dose 8-Gy CRI for painful TF after concurrent chemoradiation therapy to a total radiation dose of 52 to 66 Gy between 2007 and 2012. Primary endpoints included significant pain relief (SPR) defined as a ≥2 point decrement in the Visual Analogue Scale for Pain inventory (VAS-P), time to pain relief, and duration of pain control. Secondary objectives were survival and prognostic factors. RESULTS: Treatment was well tolerated, with only 5.1% grade 3 pneumonitis and 1.3% grade 2 esophagitis. Pre-CRI median and post-CRI minimum VAS-P were 7 and 3 (P<.001), respectively. SPR was noted in 67 (85.9%) patients, and only 3 (3.9%) scored progressive pain. Median time to lowest VAS-P and duration of pain control were 27 days and 6.1 months, respectively. Median overall survival (OS) was 7.7 months, and the 1-year OS rate was 26.5%. On multivariate analyses, lower Eastern Cooperative Oncology group score (1-2; P<.001), absence of anemia (P=.001), and fewer metastatic sites (1-2; P<.001) were found to be associated with longer OS. CONCLUSIONS: Single-dose 8-Gy CRI provides safe, effective, and durable pain palliation for TF in radically irradiated M-NSCLC patients. Because of its convenience, lower cost, and higher comfort, the present protocol can be considered an appropriate option for patients with limited life spans.

[Treatment of dyspnea and other respiratory symptoms in palliative care]. / Hengenahdistuksen ja muiden hengitystieoireiden palliatiivinen hoito.

Respiratory symptoms cause much of suffering in palliative care. Opioids are the first-line drugs in symptomatic treatment, and a therapeutic intervention with benzodiazepines may also be justified. If the patient does not have hypoxia, oxygen and air stream have similar effects on dyspnea. Cough reflex is attenuated with opioids, and symptoms due to respiratory secretions are alleviated with anticholinergic drugs and mucolytics. Physical therapy and methods of respiratory management are profitable in the treatment of respiratory symptoms. Radiation therapy relieves cancer-induced hemoptysis, cough, chest pain and dyspnea.

Indications and limitations of radiotherapy in malignant pleural mesothelioma.

In patients with malignant pleural mesothelioma, radiotherapy is useful in the palliation of symptoms of chest pain and painful masses. Prophylactic chest wall irradiation appears to reduce the incidence of chest wall recurrences at incision sites. An area of active ongoing research is the role of high-dose hemithorax irradiation after extrapleural pneumonectomy for early stage disease. In carefully staged patients, this approach has resulted in a marked reduction in local tumor recurrences, although nearly one half of patients subsequently developed isolated distant metastases. Relevant issues for planning postoperative radiotherapy in such patients are highlighted. These multimodality protocols await evaluation within prospective randomized clinical trials, and effective systemic chemotherapy regimens will also need to be integrated into such approaches.